He argued that failing to review the guidance could lead to an increase in litigation due to a greater number of adverse outcomes.
"It needs to be looked at because, from the minister's point of view and the State's point of view, this is going to result in more litigation because there will inevitably be more adverse outcomes," he said.
In an Irish Times opinion piece, Dr Boylan pointed to the findings of the recent Ockenden report in the UK, which examined maternity services and found that more than 500 mothers and babies experienced avoidable harm or died. The report identified a range of contributing factors, including failures in foetal monitoring, and concluded that existing oversight systems were no longer fit for purpose.
He said Ireland should avoid repeating the mistakes identified in the UK.
"We don't want to import into Ireland the disastrous approaches that have resulted in so much suffering in the UK," he said.
One of his principal concerns is the guidance stating that established labour begins at 4cm cervical dilation. He warned that pregnant people may delay seeking care because they have no way of knowing when they have reached that stage.
"The guidelines are silent on how a woman is supposed to know at home that her cervix has reached 4cm, and that makes no sense whatsoever," he said.
Dr Boylan also questioned the recommendations on foetal monitoring, saying there is no clear clinical justification for delaying routine monitoring until labour is considered established at 4cm dilation.
"The guidelines say you don't need to start monitoring the baby's heartbeat until the woman is in the first stage of labour, which they define as beginning at 4cm. That has associated risks because you are not listening to the baby's heartbeat," he said.
Ireland introduced the National Maternity Strategy in 2016 to standardise maternity care across hospitals and improve outcomes for mothers and babies. Clinical guidelines are developed by the National Women and Infants Health Programme in collaboration with the Institute of Obstetricians and Gynaecologists and are updated periodically.
However, Dr Boylan believes the latest guidelines require urgent review.
He said the continued use of the term "latent labour" is particularly concerning because it implies labour has not begun until the cervix reaches 4cm dilation.
"In other words, a woman can be at home, unmonitored, with the baby also unmonitored, wondering when she should go to hospital because she has no way of knowing when she is 4cm dilated," he said.
Dr Boylan explained that the concept of latent labour originated in the 1950s through the work of New York obstetrician Emmanuel Friedman, who observed that many women took 12 hours or more to reach 4cm dilation before labour progressed more rapidly.
While the concept subsequently became established in obstetric practice, Dr Boylan said decades of research have since shown it can contribute to poorer outcomes.
"We can see that from the report in the United Kingdom, where babies have suffered, babies have died and women have suffered," he said.
Having delivered and reviewed tens of thousands of births during his career, Dr Boylan said he has seen women experiencing painful contractions being told they are not in labour because they have not yet reached 4cm dilation.
"That is just not acceptable," he said.
He added that his experience reviewing coroner's cases and medical negligence claims suggests the concept of latent labour is increasingly emerging as a contributing factor in catastrophic outcomes.
"I am seeing that creeping in now and it needs to be revised and reviewed," he said.
